Biceps femoris is one of the hamstrings muscles that originates from ischial tuberosity and inserts into the head of fibula, lateral collateral ligament and lateral tibial condyle (long head). Short head originates from middle third of linea aspera and lateral supracondylar ridge of femur and insertion is same as long head. Biceps femoris flexes the knee, rotates tibia laterally and long head also extends the hip.
Snapping of the Biceps femoris tendon is the uncommon condition that pain occurs outside of the knee where the insertion is due to snapping the tendon off the bone.
- Trauma *2,3
- Overuse and repetitive loading *5
- Sports involved such as a sudden pivot, stop, jump and kick
- Intensive training and exercise
- Flat feet
- Anomalous tendon insertion of biceps femoris *6
Signs and symptoms
- Stop patients from doing activities *2, 3
- Localised pain with activity
- Pain or snapping sound when extend the knee from flexed position *3,4
- Football, basketball players and runners
- Knee flexed at 80-120 degrees with tibial rotation *5,6
- Strengthen training
This condition occurs when knee is flexed 80-120 degrees with tibial rotation. Therefore, strengthening hip abductor and foot inversion muscles such as tibial anterior and tibialis posterior may help this condition.
Tests for snapping biceps femoris tendon
- Knee ROM
- McMurray’s test to check biceps femoris tendon of the insertion*5 https://www.youtube.com/watch?v=lwDFPAyGGgI
- ITB syndrome
- Patellofemoral syndrome
- Meniscal pathology
As this condition is quite rare and not enough cases, not many researches have been done. However, it is great for practitioners to keep this in mind in order to identify the issue.
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- Giovanni vavalle and Michele capozzi Symptomatic snapping knee from biceps femoris tendon subluxation: am unusual case of lateral pain in a marathon runner 2010 11(4):263-266
- Kristensen G, Nielsen K, Blyme PJH. Snapping knee from biceps femoral tendon. A case report. Acta Orthop Scand. 1989;60:621.
- Bach BR, Minihane K. Subluxation biceps femoris tendon: an unusual case of lateral knee pain in a soccer athlete. A case report. Am J Sport Med. 2001;29(1):93–95.
- Crow AC, Quach T, McAllister DR (2009) Partial tendon release for treatment of a syntomatic snapping biceps femoris tendon: a case report. Sports Health 1(5):435–437
- Hernandez JA, Rius M, Noonan KJ. Snapping knee from anomalous biceps femoris tendon insertion: a case report. Iowa Orthop J. 1996;16:161–163